Factors Associated With Calf Muscle Endurance Recovery 1 Year After Achilles Tendon Rupture Repair

Bostick, Geoff P.; Jomha, Nadr M.; Suchak, Amar A.; Beaupré, Lauren A

doi:10.2519/jospt.2010.3204

Cited by 73 publications

(69 citation statements)

References 17 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the PATH-2 trial, we used and assessed a single PRP preparation system based on a previous study 86 to standardise the procedure. There are three methods to prepare PRP: (1) gravitational platelet sequestration or centrifugation, (2) standard cell separators and (3) selective filtration technology or plateletpheresis.…”

Section: Limitationsmentioning

confidence: 99%

Platelet-rich plasma injection for adults with acute Achilles tendon rupture: the PATH-2 RCT

et al. 2019

View full text Add to dashboard Cite

Background Achilles tendon rupture (ATR) has a long healing period, which is challenging for patients and clinicians. Platelet-rich plasma (PRP) is an autologous concentration of platelets thought to improve tendon function recovery. Although preliminary research has indicated positive effects, there is, as yet, no evidence of clinical efficacy from adequately powered robust clinical trials. Objectives The objectives were to determine the clinical efficacy of PRP in patients with acute ATR using an objective mechanical muscle–tendon function measure and patient-reported outcome measures (PROMs), and to determine which PRP components contribute to its mechanism. Design This was a multicentre, parallel-group, participant- and outcome assessor-blinded randomised controlled trial (RCT) comparing PRP with placebo. Two embedded substudies investigated the PRP’s quality and composition and its effects on healing tendon tissues. Setting This trial was set in trauma and orthopaedic surgery departments in 19 NHS hospitals in England and Wales. Participants Adults with acute ATR presenting within 12 days of injury to be treated non-surgically were eligible. Patients with platelet dysfunction or leg functional deficiency were excluded. Interventions Participants were randomised 1 : 1 to the PRP injection group or the placebo group (dry needle in the rupture gap) by central computer-based randomisation using minimisation, stratified by centre and age. Main outcome measures The primary outcome measure was the Limb Symmetry Index (LSI) of work during the heel-rise endurance test at 24 weeks. Secondary outcomes measures, collected at 4, 7, 13 and 24 weeks, were repetitions, maximum heel-rise height, Achilles tendon Total Rupture Score (ATRS), quality of life (as measured using the Short Form questionnaire-12 items version 2), pain and participant goal attainment. Needle biopsies of the affected tendon zone were taken under ultrasound guidance at 6 weeks from 16 participants from one centre. Whole blood was analysed for cell count. PRP was analysed for cell count, platelet activation and growth factor concentration. The primary analysis was intention to treat. Results A total of 230 participants were randomised: 114 to the PRP group (103 treated) and 116 to the placebo group (all treated). One participant withdrew after randomisation but before the intervention. At 24 weeks, 201 out of 230 participants (87.4%) completed the primary outcome and 216 out of 230 participants (93.9%) completed the PROMs. The treatment groups had similar participant characteristics. At 24 weeks, there was no difference in work LSI (mean difference –3.872; 95% confidence interval –10.454 to 2.710; p = 0.231), ATRS, pain or goal attainment between PRP- and placebo-injected participants. There were no differences between the groups in any PROM at any time point or in complication rates, including re-rupture and deep-vein thrombosis. There was no correlation between work LSI and platelet activation in PRP, or erythrocyte, leucocyte or platelet counts in whole blood or PRP. Biopsies showed similar cellularity and vascularity between groups. Conclusions This trial design and standardised PRP preparation gives the first robust RCT evidence about PRP’s role in managing ATR, which suggests that PRP offers no patient benefit. Equally robust evidence to investigate PRP application in tendon and soft tissue injuries is required. The 24-month follow-up will be completed in April 2020. Trial registration Current Controlled Trials ISRCTN54992179. Funding This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership. The trial was supported by the NIHR Biomedical Research Centre, Oxford, and the NIHR Fellowship programme.

show abstract

Section: Limitationsmentioning

confidence: 99%

Platelet-rich plasma injection for adults with acute Achilles tendon rupture: the PATH-2 RCT

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Rupture of the Achilles tendon leads to muscle weakness[17] and decreased endurance[18], which persists to 10 years following injury[19–22]. Performance of higher-level activities, such as those required for return to play (RTP), also demonstrate large variations between individuals[17].…”

Section: Introductionmentioning

confidence: 99%

“…14 16 There have been a variety of proposed reasons that may contribute to why not all patients are able to return to play. Rupture of the Achilles tendon leads to muscle weakness 17 and decreased endurance, 18 which persists to 10 years following injury. [19][20][21][22] Performance of higher level activities, such as those required for return to play (RTP), also demonstrate large variations between individuals.…”

Section: Introductionmentioning

confidence: 99%

Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play

2016

View full text Add to dashboard Cite

Aim This systematic review and meta-analysis sought to identify return to play (RTP) rates following Achilles tendon rupture and evaluate what measures are used to determine RTP. Design Systematic review and meta-analysis. Studies were assessed for risk of bias and grouped based on repeatability of their measure of RTP determination. Data Sources PubMed, CINAHL, Web of Science, and Scopus databases were searched to identify potentially relevant articles. Eligibility criteria for selecting studies Studies reporting return to play/sport/sport activity in acute, closed Achilles tendon rupture were included. Results A total of 108 studies encompassing 6,506 patients were included for review. Eighty-five studies included a measure for determining RTP. The rate of RTP in all studies was 80% (CI95%: 75 – 85%). Studies with measures describing determination of RTP reported lower rates than studies without metrics described, with rates being significantly different between groups (p < 0.001). Conclusions Eighty percent of patients returned to play following Achilles tendon rupture, however, the return to play rates are dependent on the quality of the method used to measure RTP. To further understand RTP after Achilles tendon rupture, a standardised, reliable, and valid method is required.

show abstract

“…[1][2][3] One reason for the difficulties in improving the intervention and treatment of ATR is a lack of early markers that can be used to predict the healing progress and the long-term outcome. 4 During the last decade, a method to assess the healing progression of ATR was developed by using a microdialysis technique, 5 in which a small catheter is placed in the metabolically active part of the tendon, that is, the paratenon.…”

Section: Introductionmentioning

confidence: 99%

Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture

Alim

Svedman

Edman³

et al. 2016

BMJ Open Sport Exerc Med

View full text Add to dashboard Cite

ObjectivePatients who sustain acute Achilles tendon rupture (ATR) exhibit variable and mostly impaired long-term functional, and patient-reported outcomes. However, there exists a lack of early predictive markers of long-term outcomes to facilitate the development of improved treatment methods. The aim of this study was to assess markers of tendon callus production in patients with ATR in terms of outcome, pain, and fatigue.Study design and settingProspective cohort study; level of evidence 2. Outpatient orthopaedic/sports medicine department.PatientsA total of 65 patients (57 men, 8 women; mean age 41±7 years) with ATR were prospectively assessed.AssessmentsMarkers of tendon callus production, procollagen type I N-terminal propeptide (PINP) and procollagen type III N-terminal propeptide (PIIINP), were assessed 2 weeks postoperatively using microdialysis followed by enzymatic quantification. Normalised procollagen levels (n-PINP and n-PIIINP) were calculated as the ratio of procollagen to total protein content. Pain and fatigue were assessed at 1 year using reliable questionnaires Achilles tendon Total Rupture Score (ATRS).ResultsPatients exhibited fatigue (77.6%) and pain (44.1%) to some extent. Higher levels of n-PINP (R=0.38, p=0.016) and n-PIIINP (R=0.33, p=0.046) were significantly associated with less pain in the limb. Increased concentrations of PINP (R=−0.47, p=0.002) and PIIINP (R=−0.37, p=0.024) were related to more self-reported fatigue in the leg. The results were corroborated by multiple linear regression analyses.ConclusionsAssessment of procollagen markers in early tendon healing can predict long-term patient-reported outcomes after ATR. These novel findings suggest that procollagen markers could be used to facilitate the development of improved treatment methods in patients who sustain ATR.Trial registration numbersNCT01317160: Results. NCT02318472: Pre-results.

show abstract

Factors Associated With Calf Muscle Endurance Recovery 1 Year After Achilles Tendon Rupture Repair

Cited by 73 publications

References 17 publications

Platelet-rich plasma injection for adults with acute Achilles tendon rupture: the PATH-2 RCT

Platelet-rich plasma injection for adults with acute Achilles tendon rupture: the PATH-2 RCT

Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play

Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture

Contact Info

Product

Resources

About